Case studies of children with cochlear implant rehabilitation therapy

General data on the case:

• Biographical and case identification data – Alexia is the only daughter of a young hearing family from Sibiu. She is a much wanted and awaited child with no family history of hearing impairment.
• Case history (Anamnesis):

–           Significant medical data – Alexia was born at full term by natural birth after a normal pregnancy. It was a trouble-free pregnancy apart from the eclampsia of the last trimester of pregnancy. Alexia was born without health problems. At birth, she received an APGAR score of 9. The universal neonatal hearing screening wasn’t available at that moment at the hospital where she was born. The first time it was suspected that Alexia had hearing issues was at the age of 9 months. Her parents noticed she did not react to sounds the same way other people do. They observed that sound toys were of no relevance to her, she didn’t react when they called her by her name; also, this one time, they were on a street and heard loud sounds like a barking dog, and she didn’t react at all. That was the moment when they knew their daughter had a problem. After seeing an ENT and after some audiometric testing, at 18 months, they were told the child did not have a hearing problem. But the parents noticed that their daughter had a hearing problem and at the age of 3 they went to another ENT where several hearing tests and a CT scan were performed and they received the diagnosis of profound congenital bilateral neuro-sensorial deafness. It was decided that a cochlear implant was her best option if they managed to raise money the money for it. With external help, they raised the money and Alexia received her CI at 3 years and 8 months.

• Significant psychological data – Alexia is an amazing kid. She likes to dance and she used to be a model. With the help of a speech therapist and a good support network at home, she developed particularly good speech and spoken language. At the moment she’s fully recovered.

Ever since she was diagnosed, her parents insisted on treating her as a normal child, never making her feel different from her peers. This positive attitude along with her spoken language progress made it easier for her to socially integrate.

• Educational setting: Alexia’s implant was activated 6 weeks after implantation and right away she started seeing a speech therapist 3 times a week. During the first couple of years after receiving the implant, most of the rehabilitation process took place at home, mainly with her mother.

Alexia started going to a regular nursery school at the age of 3 years and 2 months. By then she was using a few words but mostly she used lip reading. Her teacher knew about her problems but at the request of her parents, she treated Alexia like a healthy child. After she received her implant her speaking improved quickly.

Significant social data: Alexia comes from a moderate-income family. They are 3 people living in a 2-bedroom apartment. Her mother has an engineer’s degree but at the moment works as a nurse in a dental office. She chose to give up her job for a while and get fully involved in the auditory-verbal rehabilitation process. She resumed her activity when the child turned 7 and she returned to work. Adela’s father works as a plumber.

• Age of fitting the first hearing aids and cochlear implants: Alexia received bilateral hearing aids and wore them for 1 month before receiving her CI but showed no improvement. At age 3 years and 8 months, Alexia received her first CI which was fitted 6 weeks later. The fitting went well, without any issues. She did not wear a hearing aid on the opposite ear because it did not seem efficient.

– How often and what kind of support/rehabilitation does the child/family receive?

After the first CI was activated, Alexia and her mother started going to group speech therapy 3 times a week. There, the parents were constantly educated on how to support their CI children and to stimulate spoken language.

The implantation

• age of undergoing first cochlear implantation (left side): 3 years and 8 months
  • type of implant: On her left side – Digisonic implant with a Digi processor until 2 years ago and then Oticon implant with a Saphyr processor
  • number of implants (CI and hearing aids): CI1 3 years and 8 months

– current average duration of the CI use (information from the audiologists): 14 hours/day

• other relevant information: No issues/difficulties were reported in using the devices.

What is the procedure for starting speech therapy after CI?

The importance of speech therapy and rehabilitation is discussed with the parents before implantation. There is no official rehabilitation program, so it is up to the parents to choose a speech therapist. Unfortunately, there are very few speech therapists with CI experience so sometimes it can be an accessibility issue.

The Speech Therapy used in rehabilitation

Alexia saw a CI-focused speech therapist 3 times a week for a session of about 45-50 min. The therapy was only based on verbal-oral communication and training the parents in the process of auditory-verbal rehabilitation.

Very soon after the first fitting, she started reacting to speech sounds and by the age of 5, she was able to comprehend speech as well as speak in full sentences herself. Outside therapy, her parents would vocalize absolutely everything that was happening around her. They would ask her questions and teach her to verbalize her answers.

Alexia never learned or used sign language. She received regular audiological support and adjustments.

Results

SWOT analysis by Alexia’s mother

Strengths: Alexia benefitted from quality speech therapy based on parent training. Her parents always treated her like a normal child, without denying her disability. They always thought that she could do all the things that a hearing child could do and never set limits for her. They always encouraged her to try new things, always supported her, and worked to increase her self-confidence.

Weaknesses: Alexia’s case evolved with little to no weaknesses.

Opportunities: Over the years, Alexia and her mother got to spend quality time together. They wanted her to be in touch with other hearing-impaired children like her so she would not feel any different.

Threats: They have had little to no negative experiences in the rehabilitation process. Alexia had an incredibly good team (parents – speech therapist – audiologist) helping her every step of the way. Her parents have a highly positive outlook on her future and are confident her life will in no way be hampered by her deafness.

 SWOT analysis by Alexia

Strengths: Alexia is thrilled about her CI; thanks to it she can hear and so she is able to integrate much better. Most of her peers are not even aware she has a CI, that’s how well she’s recovered.

Her parents always treated her like a normal child, without denying her disability. They always thought that she could do all the things that a hearing child could do and never set limits for her. They always encouraged her to try new things, always supported her, and worked to increase her self-confidence.

Weaknesses: Alexia’s case evolved with little to no weaknesses. She would like her processor to be smaller but she’s ok with the one she has.

Opportunities: She is grateful that she was able to go to a normal school, socialize with everyone and make friends very easily. Also, she really likes music and is grateful that she can enjoy it with the help of her IC. Over the years, her situation brought her closer to her mother and they were able to spend a lot of quality time together.

Threats: They have had little to no negative experiences in the rehabilitation process. Alexia had an incredibly good team (parents – speech therapist – audiologist) helping her every step of the way. She is delighted with the way the collaboration took place.